Author + information
- Gyanendra K. Sharma, MD∗ ()
- ↵∗Medical College of Georgia, Georgia Regents University, Section of Cardiology, 1120 15th Street, BBR 6518, Augusta, Georgia 30912
I read with great interest the article by Grayburn et al. (1), which defined “severe” secondary mitral regurgitation (MR). The investigators did a great job of explaining the mechanism and application of new guidelines in the evaluation of MR. The investigators proposed that classification of a patient with severe secondary MR should be deferred until guideline-directed medical therapy or interventions are optimized.
Current guidelines for valvular heart disease define the class of valvular heart disease by echocardiographic data and symptoms, asymptomatic severe MR (stage C), and symptomatic severe MR (stage D) (2). However, the severity of MR is primarily based on the echocardiographic findings, including color Doppler, vena contracta, effective regurgitant orifice, and regurgitant volume and/or fraction. It is well known that the severity of MR is dependent on the loading conditions (blood pressure and heart rate), and that there may be disparities among various parameters for the assessment of severity. The echocardiologist reading the study may not have any knowledge about the optimization of the medical therapy, and may find it difficult not to describe a patient with severe MR if the patient meets the echocardiographic diagnostic criteria for severe MR. It seems more logical to say that the decision to recommend surgical or other invasive procedures should be deferred until the guideline-directed therapy has been optimized and the severity of MR subsequently reassessed. However, more research is needed in this area to further define the duration of optimal therapy.
Please note: Dr. Sharma has reported that he has no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Grayburn P.A.,
- Carabello B.,
- Hung J.,
- et al.
- Nishimura R.A.,
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